SIXTY-NINTH WORLD HEALTH ASSEMBLY
Provisional agenda item 13.3
A69/16
6 May 2016
Operational plan to take forward the Global
Strategy for Women’s, Children’s and
Adolescents’ Health
Committing to implementation
Report by the Secretariat
1.
Pursuant to the request in resolution WHA67.14 (2014) to continue to inform Member States
about the positioning of health in the post-2015 development agenda, this report highlights key aspects
of the Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016–2030,1 with particular
focus on country leadership and implementation. The Executive Board considered an earlier version of
this report at its 138th session, in January 2016,2 and agreed that intersessional discussions should
proceed with a view to developing a draft resolution for submission to the Health Assembly in May
20163 It proposes a timetable for the updating of national plans, investing resources in health,
strengthening implementation through resilient health systems, promoting multistakeholder
partnership and enhancing accountability. It also solicits commitments to the Global Strategy,
including to the overall goal of achieving universal health coverage, from all stakeholders concerned.
2.
In September 2015, the United Nations Secretary-General launched the Global Strategy for
Women’s, Children’s and Adolescents’ Health, 2016–2030, and the United Nations General Assembly
adopted the 2030 Agenda for Sustainable Development. The survival, health and well-being of
women, children and adolescents are essential to achieving all the Sustainable Development Goals.
The Global Strategy, an updated version of the Global Strategy on Women’s and Children’s Health,
2010–2015, includes new areas of focus and encompasses 17 health and health-related targets. These
targets were identified among the 169 targets of the Sustainable Development Goals and align with
global action plans previously endorsed by WHO Member States (see Annex 1 for a synopsis of the
targets of the Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016–2030).
1
The Global Strategy for Women’s, Children’s and Adolescents’ Health, (2016–2030): survive, thrive and transform
(http://globalstrategy.everywomaneverychild.org/ accessed 2 December 2015).
2
3
See document EB138/15.
See the summary records of the Executive Board at its 138th session, fifth meeting, section 2 and sixth meeting
(document EB138/2016/REC/2).
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THE GLOBAL STRATEGY FOR WOMEN’S, CHILDREN’S AND ADOLESCENTS’
HEALTH (2016–2030)
3.
The Global Strategy envisages a world in which every woman, child and adolescent in every
setting realizes her or his right to physical and mental health and well-being, enjoys social and
economic opportunities, and is able to participate fully in shaping prosperous and sustainable societies.
Its three main objectives are to enable individuals to:
• survive, by ending preventable deaths;
• thrive, by ensuring health and well-being; and
• transform, by expanding enabling environments.
4.
The Global Strategy provides a road map for attaining these ambitious objectives and
supporting countries in starting to implement the post-2015 agenda without delay based on the
evidence of what is needed and what works. It is relevant to all countries, including those already
having attained some of the proposed absolute national targets. Reducing subnational inequities,
ensuring universal health coverage and progressively realizing the rights to health and to health care of
every woman, child and adolescent everywhere all remain challenges in most settings.
5.
Full implementation of the Global Strategy, with increased and sustained financing over the
next 15 years, would yield tremendous social and economic returns, including an end to preventable
deaths, a 10-fold return on investments and at least US$ 100 billion in demographic dividends.1
However, large funding gaps remain in low- and lower middle-income countries with high burdens of
maternal and child mortality, which could only be filled by major increases in financing from domestic
and international sources alike. The Addis Ababa Action Agenda lays out the purpose of domestic and
international financing for development, in particular to provide fiscally sustainable and nationally
appropriate social protection systems, including those for health.2
6.
The Global Strategy was developed under the auspices of the United Nations Secretary-General
and the Every Woman Every Child movement. It was supported by discussions at the Sixty-eighth
World Health Assembly, the Group of Seven summit (Krün, Germany, 7–8 June 2015), and the InterParliamentary Union at its 132nd assembly (Hanoi, 28 March–1 April 2015). Consultations on the
development of the Global Strategy were hosted by the Governments of India, South Africa and the
United Arab Emirates, as well as by the Partners in Population and Development intergovernmental
network and the Partnership for Maternal, Newborn and Child Health. More than 7000 organizations
and individuals provided written comments or participated in the Global Strategy consultations.
Furthermore, a special supplement to the British Medical Journal, prepared by a diverse group of
1
The Global Strategy for Women’s, Children’s and Adolescents’ Health, (2016–2030): survive, thrive and transform
(http://globalstrategy.everywomaneverychild.org/ accessed 2 December 2015).
2
United Nations. Financing for Development. Addis Ababa Action Agenda of the Third International Conference on
Financing for Development (Addis Ababa, 13–16 July 2015), endorsed by the General Assembly in its resolution 69/313
(http://www.un.org/esa/ffd/wp-content/uploads/2015/08/AAAA_Outcome.pdf accessed 2 December 2015).
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global experts under WHO’s leadership, provides details on the rationale and evidence for the
interventions and strategies proposed in the Global Strategy.1
7.
To guide the transition from the Millennium Development Goals to the goals of the Agenda for
Sustainable Development, the United Nations Secretary-General appointed a High-level Advisory
Panel to provide leadership, inspire ambitious actions for women’s, children’s and adolescents’ health,
and encourage collaboration and integration between relevant sectors and work areas. The global
membership includes representatives of governments, the business community, philanthropists, young
people, civil society and the multilateral system, and reflects the diversity of the Every Woman Every
Child movement.2
NEW CHALLENGES
8.
Implementing the Global Strategy will require attention to areas that have received relatively
little in the past, including early child development and adolescent health, the health of women,
children and adolescents in humanitarian crises and fragile settings, and multisectoral responsibilities
to tackle underlying determinants of health and well-being. Overall, the Strategy seeks to ensure that
nobody is left behind and that inequities, whether among or within countries, are addressed.
9.
The importance of investing in health and development in early childhood and adolescence to
maximize the demographic dividend and optimize health along the life course is now well recognized.
WHO is leading a broadbased consultative process to develop a global framework for accelerated
action for adolescent health in follow-up to discussions on adolescent health at the Sixty-eighth World
Health Assembly,3 for submission to Member States for consideration at the Seventieth World Health
Assembly, in 2017.4 Similarly, the Secretariat will strengthen its investment to develop evidence-based
guidelines and tools for early child development, with a particular emphasis on the role of the health
sector in reaching families and children aged 0–3 years.
10. Approximately half of the global burden of maternal, newborn and child mortality weighs on
people in humanitarian crises or fragile settings. Millions of women, children and adolescents living in
such settings also face substantially increased risks of morbidity due to unsafe environments, sexual
violence and depression, yet the majority of development assistance is directed towards countries and
populations in relatively stable conditions. The Global Strategy calls for integrated humanitarian and
sustainable development action through a “contiguum approach”: tackling relief, recovery and
development simultaneously and collaboratively, and mainstreaming emergency preparedness at all
levels of the health system. It focuses on safeguarding women, children and adolescents in those
unprotected settings and upholding their human rights to the highest attainable standard of health, even
in the most difficult circumstances. In order to achieve the Sustainable Development Goals, the global
1
Towards a global strategy for Women’s, children’s, and adolescents health. The BMJ, 351, Supplement 1. 70pp,
2015 (bmj.co/who accessed 2 December 2015).
2
http://www.everywomaneverychild.org/news-events/news/1135-high-level-event-to-launch-the-globalstrategy#sthash.6QyNrmjF.dpu (accessed 29 April 2016).
3
Adolescent health, document A68/15, noted by Committee A of the Sixty-eighth World Health Assembly (summary
record of the tenth and eleventh meetings (section 3)).
4
Document A68/15 had indicated that the draft framework for accelerated action for adolescent health would be
finalized for submission to the Sixty-ninth World Health Assembly. It was subsequently decided to present the framework in
2017 in order to allow for more in-depth consultation with Member States.
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community must become more agile to act and generate greater investment to assist those at greatest
risk.
11. Recognizing the importance of investment needed in sectors other than health, and the need to
tackle social and environmental determinants to advance health outcomes and goals, governments
have a particular responsibility for coordinating policy-making and facilitating the formulation of
strategic plans with common goals, integrated responses and increased accountability across
government departments. The Health in All Policies approach is one response to meet the need for
coordinated, multisectoral actions, including those related to tackling malnutrition, air pollution, poor
water quality, sanitation and hygiene, violence, and harmful and discriminatory practices.
Nevertheless, the realities countries face mean that it is not easy to break out of existing vertical health
care programmes and approaches and foster effective multisectoral collaboration. This area will need
specific country leadership and attention when countries put the Global Strategy into practice.
12. Inequities adversely affect health outcomes among women, children and adolescents, especially
those marginalized, excluded from society, affected by discrimination, or living in underserved
communities – particularly the poorest and least educated and those living in remote areas.
Accordingly, the Global Strategy advocates policies and programmes that are equity-driven, genderresponsive and human rights-based.
IMPLEMENTING THE GLOBAL STRATEGY
13. Effective country leadership is a common thread among countries making the swiftest progress
in improving the health of women, children and adolescents. Strong leadership takes the form of, inter
alia, defining clear strategic directions and targets, and working towards them by effective
collaboration among various arms of government working closely with communities, civil society,
young people, development partners and the private sector. Leadership is also visible in the role of
parliament (and often among women parliamentarians) through policy- and law-making, budgeting
and increased accountability for women’s, children’s and adolescents’ health. Modalities of
implementation will be determined by national needs and priorities through updated country plans and
supported as needed by WHO and other organizations in the United Nations system and by other
partners in the Every Woman Every Child movement.1
14. Among the 169 targets of the Sustainable Development Goals, 17 health and health-related
targets directly relevant to improving the health of women, children and adolescents have been
identified in the Global Strategy as the key drivers of action. As the task of reaching these targets falls
within the remit of multiple sectors and stakeholders, implementing the Global Strategy will require
the harnessing of the power of partnership through commitments and collaboration at all levels.
15. It is recommended that every government undertake the following key activities in order to put
the Global Strategy into practice, thereby contributing simultaneously to achieving the overarching
goal of universal health coverage
(a) Use the 17 health and health-related targets specified in the Global Strategy as part of a
national process to update national policies, strategies, plans and budgets for the period
2016–2030. Pay due consideration to all the health-related targets with specific attention to
1
The Every Women Every Child secretariat is hosted at the Office of the United Nations Secretary-General in New
York (http://www.everywomaneverychild.org/ accessed 29 April 2016).
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inequities in health outcomes, intervention coverage, service quality, availability and access, as
well as multisectoral determinants of health and well-being and long-term demographic and
macroeconomic trends.
(b) Develop a sustainable, evidence-informed, health financing strategy that maximizes and
increases the use of domestic resources and incrementally reduces dependence on external
resources for providing essential health services, redressing inequities and tackling critical
social and environmental determinants of health.
(c) Strengthen health systems to be resilient, efficient and effective, in particular by investing
in the health workforce, quality of health service delivery, availability of essential medical
products and vaccines across the life course and in every setting, and by mainstreaming
emergency preparedness at all levels.
(d) Harness the power of partnership, reinforce multisectoral and multistakeholder
commitments and collaboration, and use governance mechanisms that have the ability to
effectively facilitate cross-sector collaboration and action; recognize the importance of informed
community engagement in planning, supporting and monitoring services so as to reach
everyone.
(e) Enhance accountability mechanisms for resources, results and rights at the national and
subnational levels by strengthening systems for civil registration and vital statistics and health
information; develop clear monitoring and evaluation frameworks, including multistakeholder
consultations, citizens’ hearings, independent reviews and parliamentary procedures, to inform
evidence-based actions; and harmonize such mechanisms and frameworks with regional and
global accountability processes to ensure progress.
16. Country plans and priorities should drive collective action among diverse stakeholders,
constituencies and sectors for women’s, children’s and adolescents’ health at the global, national and
subnational levels. In support of national priorities and plans, stakeholders should strive to strengthen
coordination and reduce fragmentation of initiatives and technical assistance, align investments in
monitoring and evaluation, and facilitate sufficient, predictable and effective financing, in accordance
with the aid effectiveness principles laid out by the international health partnership IHP+1 and those
underlying the Paris Declaration on Aid Effectiveness and Accra Agenda for Action.2
17. A five-year operational framework has been developed to accompany the Global Strategy and to
serve as a resource for national governments and a wide variety of stakeholders within countries
whose contributions are vital to improving the health and well-being of women, children and
adolescents, including civil society, the private sector and development partners. It offers guidance and
options for consideration as countries translate the Global Strategy into national and subnational
strategies and plans, starting with the period 2016–2020 and building on country-level processes and
plans already underway. The document presents activities to implement at the country level around the
nine action areas of the Global Strategy, examples of country experiences and a rich repository of
operational tools. It is neither prescriptive nor exhaustive, and will be updated periodically.
1
http://www.internationalhealthpartnership.net/en/about-ihp/seven-behaviours/ (accessed 2 December 2015).
2
http://www.oecd.org/dac/effectiveness/34428351.pdf (accessed 2 December 2015).
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18. As the lead technical arm for the implementation the Global Strategy, the H6 partnership,
comprising UNAIDS, UNFPA, UNICEF, UN WOMEN, WHO and the World Bank Group, is
leveraging its collective strengths and complementary advantages and capacities to support countries
with a high burden of maternal, newborn, child and adolescent mortality and morbidity in their efforts
to improve the survival, health and well-being of every woman, newborn, child and adolescent. The
H6 will provide coordinated support, with a focus on reaching people and places most in need, through
three major roles: (i) facilitating the provision of technical support to countries; (ii) supporting the
alignment of stakeholders on national priorities and facilitating multisectoral collaborations; and
(iii) supporting evidence-based advocacy for women’s, children’s and adolescents’ health.
19. The newly established Global Financing Facility in support of Every Woman Every Child aims
to accelerate efforts towards the implementation of the Global Strategy by coordinating and
harmonizing external funding flows in support of national plans, assisting governments in identifying
strategies to increase domestic resources for health progressively, and reducing inefficiency in health
spending over time.1 The Facility will provide an opportunity for 62 low- and lower middle-income
countries to access substantial new funding for women’s, children’s and adolescents’ health, including
through the World Bank’s Global Financing Facility Trust Fund. Currently 12 countries have the
option of support from the Global Financing Facility Trust Fund linked to International Development
Association loans.
COMMITMENTS TO THE GLOBAL STRATEGY
20. When the Global Strategy was launched at the United Nations General Assembly in September
2015, more than 40 governments and more than 100 international organizations, philanthropic
foundations, United Nations system bodies, civil society and the private sector stakeholders committed
themselves to it. Making a commitment should stimulate action, build partnership and generate
investment. Partners in the Every Woman Every Child movement will track commitments and
contribute to mobilizing the necessary resources. All Member States are invited to specify their
commitments to implementing the Global Strategy and indicate what specifically they will do to reach
its targets and realize its strategic actions.
MEASURING PROGRESS IN IMPLEMENTATION OF THE GLOBAL STRATEGY
21. In the Declaration in the General Assembly’s resolution adopting the 2030 Agenda for
Sustainable Development,2 governments committed themselves to follow up on and review, at
national, regional and global levels, the progress made in implementing its goals and targets over the
coming 15 years. The Declaration provides general guidance on follow-up and review. The indicator
framework for all Sustainable Development Goals will be finalized in July 2016. WHO will play a
central coordinating role in the global monitoring of health-related targets and indicators of the
Sustainable Development Goals and thereby contribute to monitoring the implementation of the
Global Strategy. Monitoring is a crucial aspect of the accountability action area of the Global Strategy,
detailed below. Reporting and reviews will be conducted on an annual basis. Regular country-led
reviews of progress are the basis for all regional and global reviews. Alignment through a common
1
The Global Financing Facility in support of Every Woman Every Child (http://www.who.int/lifecourse/partners/global-strategy/global-financing-facility/en/ accessed 2 December 2015) was launched in July 2015.
2
In United Nations General Assembly resolution 70/1, Transforming our world: the 2030 Agenda for Sustainable
Development (http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&referer=https://
sustainabledevelopment.un.org/post2015/transformingourworld&Lang=E accessed 2 December 2015).
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platform is essential in order to minimize the reporting burden on countries and maximize the impact
of reviews on subsequent action.
ACCOUNTABILITY
22. Global accountability for the Global Strategy will be consolidated in a unified framework,
building on the recommendations of the Commission on Information and Accountability for Women’s
and Children’s Health,1 set up in 2011 to monitor progress on resources and results towards the Global
Strategy for Women’s and Children’s Health 2010–2015, including new areas of focus of the Global
Strategy. In an effort to harmonize global reporting, minimize the reporting burden on countries and
support cost-effectiveness, an Independent Accountability Panel2 will prepare annually a report
synthesizing the state of women’s, children’s and adolescents’ health from information provided by
organizations in the United Nations system and independent groups. The United Nations SecretaryGeneral appointed the panel’s members through a transparent selection process managed by the Board
of the Partnership for Maternal, Newborn and Child Health, whose secretariat will facilitate the
panel’s work. The panel’s annual report will review progress towards achieving the Global Strategy
objectives and targets, and provide recommendations and guidance to all stakeholders on how to
accelerate progress. It will include reporting of progress towards related targets in other Sustainable
Development Goals than health, such as the target on eliminating all forms of violence against women
and girls, gender equity and education. The report will be submitted to the Secretary-General in time
for deliberations by the High-level Political Forum on Sustainable Development. The panel’s initial
report is expected to be published to coincide with the Seventy-first session of the United Nations
General Assembly, in 2016, and the first full accountability report will be issued in 2017 for the
consideration of the High-level Political Forum on Sustainable Development and the World Health
Assembly.
23. In order to assess the implementation of the Global Strategy and contribute to accountability, a
set of milestones for 2016–2020 is proposed (Annex 2).
ACTION BY THE HEALTH ASSEMBLY
24.
The Health Assembly is invited to note the report.
1
See the final report of the independent Expert Review Group on Information and Accountability for Women’s and
Children’s Health of the Accountability for Women’s and Children’s Health (http://www.who.int/
woman_child_accountability/ierg/news/ierg_2015_report_launch/en/ accessed 7 December 2015).
2
http://www.who.int/pmnch/media/news/2016/iap/en/ (accessed 29 April 2016).
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ANNEX 1
AT A GLANCE: THE GLOBAL STRATEGY FOR WOMEN’S,
CHILDREN’S AND ADOLESCENTS’ HEALTH
VISION
GUIDING PRINCIPLES
By 2030, a world in which every woman, child and
adolescent in every setting realizes their rights to
physical and mental health and well-being, has social
and economic opportunities, and is able to participate
fully in shaping prosperous and sustainable societies.
Implementing the Global Strategy, with increased and
sustained financing, would yield tremendous returns
by 2030:
– An end to preventable maternal, newborn, child
and adolescent deaths and stillbirths
– At least a 10-fold return on investments through
better educational attainments, workforce
participation and social contributions
– At least US$ 100 billion in demographic dividends
from investments in early childhood and
adolescent health and development
– A “grand convergence” in health, giving all
women, children and adolescents an equal chance
to survive and thrive
–
–
–
–
–
–
–
–
–
–
–
–
Country-led
Universal
Sustainable
Human rights-based
Equity-driven
Gender-responsive
Evidence-informed
Partnership-driven
People-centred
Community-owned
Accountable
Aligned with development effectiveness and
humanitarian norms
OBJECTIVES AND TARGETS
(aligned with the Sustainable Development Goals to be achieved by 2030)
SURVIVE
End preventable deaths
• Reduce global maternal
•
•
•
•
8
mortality to less than 70 per
100 000 live births
Reduce newborn mortality to at
least as low as 12 per 1000 live
births in every country
Reduce under-five mortality to
at least as low as 25 per 1000
live births in every country
End epidemics of HIV,
tuberculosis, malaria, neglected
tropical diseases and other
communicable diseases
Reduce by one third premature
mortality from
noncommunicable diseases and
promote mental health and wellbeing
THRIVE
Ensure health and well-being
TRANSFORM
Expand enabling environments
• End all forms of malnutrition
• Eradicate extreme poverty
• Ensure that all girls and boys
•
•
•
•
and address the nutritional
needs of children, adolescent
girls, and pregnant and lactating
women
Ensure universal access to
sexual and reproductive health
care services (including for
family planning) and rights
Ensure that all girls and boys
have access to good-quality
early childhood development
Substantially reduce pollutionrelated deaths and illnesses
Achieve universal health
coverage, including financial
risk protection and access to
quality essential services,
medicines and vaccines
•
•
•
•
•
complete primary and
secondary education
Eliminate all harmful practices,
discrimination and violence
against women and girls
Achieve universal access to
safe and affordable drinking
water and to sanitation and
hygiene
Enhance scientific research,
upgrade technological
capabilities and encourage
innovation
Provide legal identity for all,
including birth registration
Enhance the global partnership
for sustainable development
Annex 1
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ACTION AREAS
(based on evidence of what is required to reach the objectives)
1. Country leadership
Reinforce leadership and management links and capacities at all levels; promote
collective action.
2. Financing for
health
Mobilize resources; ensure value for money; adopt integrative and innovative
approaches.
3. Health system
resilience
Provide good-quality care in all settings; prepare for emergencies; ensure universal
health coverage.
4. Individual
potential
Invest in individuals’ development; support people as agents of change; address
barriers with legal frameworks.
5. Community
engagement
Promote enabling laws, policies and norms; strengthen community action; ensure
inclusive participation.
6. Multisectoral
action
Adopt a multisectoral approach; facilitate cross-sector collaboration; monitor
impact.
7. Humanitarian and
fragile settings
Assess risks, human rights and gender needs; integrate emergency response; address
gaps in the transition to sustainable development.
8. Research and
innovation
Invest in a range of research and build country capacity; link evidence to policy and
practice; test and scale up innovations.
9. Accountability
Harmonize monitoring and reporting; improve civil registration and vital statistics;
promote independent review and multistakeholder engagement.
IMPLEMENTATION
Country-led implementation supported by the Every Woman Every Child movement and an operational
framework. The power of partnership harnessed through stakeholder commitments and collective action. We
all have a role to play.
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ANNEX 2
PROPOSED MILESTONES FOR THE IMPLEMENTATION OF THE GLOBAL
STRATEGY FOR WOMEN’S, CHILDREN’S AND ADOLESCENTS’ HEALTH
Proposed milestones for 2016–2017
Proposed milestones for 2018–2020
• All countries have reviewed their local situation
• All countries have developed a health financing
of women’s, children’s and adolescents’ health,
and set trajectories to achieve the targets proposed
in the Global Strategy. For countries that have
achieved proposed absolute targets, eliminating
inequities in health outcomes of women, children
and adolescents will be a priority.
strategy that progressively increases the allocation
of domestic resources and facilitates the
attainment of the national goals and targets for
women’s, children’s and adolescents’ health.
• Countries accounting for 95% of the global
burden of maternal, newborn and child mortality
show demonstrable progress towards ending
preventable mortality according to the nationally
identified targets.
• All countries have updated or developed plans for
women’s, children’s and adolescents’ health to
achieve the targets and ensure that they are fully
integrated into national health sector plans.
• All countries have adopted the Global Strategy on
• Based on individual country assessments, civil
registration and vital statistics (CRVS) systems
are aligned with international standards; regular
census schedules are established; household
surveys are conducted; and national health
facilities have information capacities to improve
quality of services for women, children and
adolescents and conduct surveillance and
response.
Human Resources for Health, and have developed
health labour market assessments and action plans
to strengthen the health workforce towards
achieving universal health coverage (UHC).
• The global Health Data Collaborative for
measurement of core indicators is fully functional,
facilitating timely data generation and synthesis in
countries and providing essential information on
progress.
• All countries are conducting annual health sector
reviews with due attention to results, resources
and rights for women’s, children’s and
adolescents’ health.
• In countries in fragile settings integrated funding
is provided to cover the continuum of
humanitarian, recovery, reconstruction and
development activities with a particular attention
to the needs of women, children and adolescents.
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